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  • 1. Ahlström, Fredrik
    et al.
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    von Rosen, Anette
    Does gender matter at triage?2007Inngår i: Australasian emergency nursing journal, ISSN 1574-6267, Vol. 10, nr 4, s. 202-203Artikkel i tidsskrift (Fagfellevurdert)
  • 2. Amritzer, Maria
    et al.
    Göransson, Katarina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska inst, Sweden; Karolinska Univ Hosp, Sweden.
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska inst, Sweden; Karolinska Univ Hosp, Sweden.
    Nymark, Carolin
    A new perspective of missed nursing care – the emergency department context: a descriptive, cross-sectional study2024Inngår i: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 50, nr 3, s. 392-402Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting. Methods: Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE survey -Swedish version was used for data collection. Results: Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants. Discussion: The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in -hospital wards.

    Fulltekst (pdf)
    fulltext
  • 3. Asplund, Kjell
    et al.
    Castrén, Maaret
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Farrokhnia, Nasim
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Jonsson, Håkan
    Lind, Lars
    Oredsson, Sven
    Rognes, Jon
    SBU om "lean": Processorienterat arbetssätt på akuten ger kortare ledtider2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 17Artikkel i tidsskrift (Annet vitenskapelig)
  • 4. Asplund, Kjell
    et al.
    Castrén, Maaret
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Farrokhnia, Nasim
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Jonsson, Håkan
    Lind, Lars
    Oredsson, Sven
    Rognes, Jon
    Triage och flödesprocesser på akutmottagning2010Bok (Annet vitenskapelig)
  • 5. Berg, Lena
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Avbrott på akutmottagning2011Inngår i: 6:e nationella konferensen om patientsäkerhet, Stockholm, 2011Konferansepaper (Fagfellevurdert)
  • 6. Berg, Lena
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Multitasking and interruptions of emergency department clinicians' activities2011Inngår i: College of Emergency Nursing Australasia International Conference, Adelaide, Australia, 2011Konferansepaper (Fagfellevurdert)
  • 7. Berg, Lena
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    The presence of emergency department crowding at a Swedish University hospital.: A longitudinal study using two crowding indicators as measures.2018Konferansepaper (Fagfellevurdert)
  • 8.
    Berg, Lena
    et al.
    Akutkliniken Karolinska Universitetssjukhuset Solna ; Institutionen för Medicin Solna, Karolinska Institutet.
    Källberg, Ann-Sofie
    kutkliniken, Falu Lasarett ; Institutionen för Medicin Solna, Karolinska Institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Karolinska institutet.
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Avbrott och störning i arbetet för akutmottagningspersonal - är det någon skillnad?2014Konferansepaper (Fagfellevurdert)
  • 9.
    Berg, Lena
    et al.
    Karolinska institutet.
    Källberg, Ann-Sofie
    Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Karolinska institutet.
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Interruptions and disturbances in emergency department work assignments2014Konferansepaper (Fagfellevurdert)
  • 10.
    Berg, Lena M
    et al.
    Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Östergren, Jan
    Discacciati, Andrea
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department2019Inngår i: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 74, nr 3, s. 345-356Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.

    METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.

    RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.

    CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.

  • 11.
    Berg, Lena M
    et al.
    Karolinska University Hospital; Karolinska Institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments2012Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 19, nr 4, s. 246-251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians.

    Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.

    Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses’ and doctors’ offices were the most common locations for multitasking in the emergency department.

    Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

  • 12.
    Berg, Lena M
    et al.
    Karolinska Institutet; Karolinska University Hospital.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital2019Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, s. 50-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Describe the longitudinal development of crowding and patient/emergency department (ED) characteristics at a Swedish University Hospital.

    METHODS: A retrospective longitudinal registry study based on all ED visits with adult patients during 2009-2016 (N = 1,063,806). Patient characteristics and measures of ED crowding (ED occupancy ratio, length-of-stay [LOS], patients/clinician's ratios) were extracted from the hospital's electronic health record. Non-parametric analyses were conducted.

    RESULTS: The proportion of unstable patients (triage level 1-2) increased while the proportion of admitted patients decreased. All crowding variables were stable, except for LOS, which increased by 9 min/visit/year (95% CI: 8.8-9.1). LOS for visits by patients ≥ 80 years increased more compared to those 18-79 (248 min vs. 190 min, p < 0.001). Unstable patients increased their median LOS compared to stable patients (triage level 3-5). LOS for discharged patients increased with an average of 7.7 min/year (95% CI: 7.5-7.9) compared to 15.5 min/year (95% CI: 15.2-15.8) for those being admitted.

    CONCLUSION: Fewer admissions, despite an increase of unstable patients, is likely related to lack of in-hospital beds and contributes to ED crowding. The increase in median ED LOS, especially for patients in the subgroups unstable, ≥80 years and admitted to in-hospital care reflects this problem.

  • 13.
    Berg, Lena M
    et al.
    Karolinska University Hospital.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Djärv, Therese
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Reasons for interrupting colleagues during emergency department work: a qualitative study2016Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, nr SI, s. 21-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

    METHOD: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

    RESULTS: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

    CONCLUSION: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

  • 14.
    Berg, Lena M
    et al.
    Karolinska Institutet; Karolinska University Hospital.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Department of Medicine Solna, Karolinska Institutet; Department of Emergency Medicine, Falun Hospital.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Djärv, Therese
    Brixey, Juliana J
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Factors influencing clinicians' perceptions of interruptions as disturbing or non-disturbing: a qualitative study2016Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 27, s. 11-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Emergency departments consist of multiple systems requiring interaction with one another while still being able to operate independently, creating frequent interruptions in the clinical workflow. Most research on interruptions in health care settings has focused on the relationship between interruptions and negative outcomes. However, there are indications that not all interruptions are negatively perceived by those being interrupted. Therefore, this study aimed to explore factors that influence when a clinician perceives interruptions as non-disturbing or disturbing in an emergency department context.

    METHOD: Explorative design based on interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. Data were analyzed using qualitative content analysis.

    RESULT: Factors influencing whether emergency department clinicians perceived interruptions as non-disturbing or disturbing were identified: clinician's constitution, external factors of influence and the nature of the interrupted task. The clinicians' perceptions were related to a complex of attributes inherent in these three factors at the time of the interruption. Thus, the same type of interruption could be perceived as either non-disturbing or disturbing contingent on the surrounding circumstances in which the event occurred.

    CONCLUSION: Emergency department clinicians' perceptions of interruptions as non-disturbing or disturbing were related to the character of identified influencing factors.

  • 15.
    Berg, Lena M
    et al.
    Karolinska Institutet; Karolinska University Hospital.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet; Department of Emergency Medicine, Falun Hospital.
    Göransson, Katarina
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden ; Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden.
    Östergren, J
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden ; Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Interruptions in emergency department work: an observational and interview study2013Inngår i: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 22, nr 8, s. 656-663Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectiv.e Frequent interruptions are assumed to have a negative effect on healthcare clinicians’ working memory that could result in risk for errors and hence threatening patient safety. The aim of this study was to explore interruptions occurring during common activities of clinicians working in emergency departments.

    Method. Totally 18 clinicians, licensed practical nurses, registered nurses and medical doctors, at two Swedish emergency departments were observed during clinical work for 2 h each. A semistructured interview was conducted directly after the observation to explore their perceptions of interruptions. Data were analysed using non-parametric statistics, and by quantitative and qualitative content analysis.

    Results. The interruption rate was 5.1 interruptions per hour. Most often the clinicians were exposed to interruptions during activities involving information exchange. Calculated as percentages of categorised performed activities, preparation of medication was the most interrupted activity (28.6%). Face-to-face interaction with a colleague was the most common way to be interrupted (51%). Most common places for interruptions to occur were the nurses’ and doctors’ stations (68%). Medical doctors were the profession interrupted most often and were more often recipients of interruptions induced by others than causing self-interruptions. Most (87%) of the interrupted activities were resumed. Clinicians often did not regard interruptions negatively. Negative perceptions were more likely when the interruptions were considered unnecessary or when they disturbed the work processes.

    Conclusions. Clinicians were exposed to interruptions most often during information exchange. Relative to its occurrence, preparation of medication was the most common activity to be interrupted, which might increase risk for errors. Interruptions seemed to be perceived as something negative when related to disturbed work processes.

  • 16.
    Crilly, Julia
    et al.
    Gold Coast Health, Southport, QLD, Australia; Griffith University, Southport, QLD, Australia.
    Sweeny, Amy
    Gold Coast Health, Southport, QLD, Australia; Griffith University, Southport, QLD, Australia.
    Muntlin, Åsa
    Uppsala University, Uppsala.
    Green, David
    Gold Coast Health, Southport, QLD, Australia.
    Malyon, Lorelle
    Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.
    Christofis, Luke
    Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.
    Higgins, Malcolm
    Women's and Children's Hospital, North Adelaide, South Australia, Australia.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Falun Hospital, Falun.
    Dellner, Sara
    Region Stockholm, Stockholm.
    Myrelid, Åsa
    Uppsala University Children's Hospital, Uppsala.
    Djärv, Therese
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Solna, Stockholm.
    Göransson, Katarina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Solna, Stockholm.
    Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study2024Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, nr 1, artikkel-id 235Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Identifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden.

    Methods: A multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission.

    Results: Of the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children's EDs in Australia had higher admission rates (South Australia: 26%, Queensland: 23%) than the mixed (adult and children's) EDs (South Australia: 13%, Queensland: 17%, Sweden: 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children's only) adjusted odds ratio (aOR):2.3 (95%CI: 2.2-2.4), arrival by ambulance aOR:2.8 (95%CI: 2.7-2.9), referral from primary health aOR:1.5 (95%CI: 1.4-1.6) and presentation with a respiratory or gastrointestinal condition (aOR:2.6, 95%CI: 2.5-2.8 and aOR:1.5, 95%CI: 1.4-1.6, respectively). Predictors were similar when each site was considered separately.

    Conclusions: Although the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.

    Fulltekst (pdf)
    fulltext
  • 17.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Berg, Lena
    Källberg, Ann-Sofie
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hur uppfattar personal på akutmottagningar avbrott i arbetet?2013Konferansepaper (Fagfellevurdert)
  • 18.
    Falk, Ann-Charlotte
    et al.
    Sophiahemmet University.
    Nymark, Carolin
    Karolinska University Hospital; Karolinska Institutet .
    Göransson, Katarina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    von Vogelsang, Ann-Christin
    Karolinska University Hospital; Karolinska Institutet .
    Missed nursing care in the critical care unit, before and during the COVID-19 pandemic: A comparative cross-sectional study2022Inngår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 72, artikkel-id 103276Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To describe and evaluate reported missed nursing care in the critical care context during different phases of the COVID-19 pandemic in Sweden.

    RESEARCH METHODOLOGY: A comparative cross-sectional design was used, comparing missed nursing care in three samples: before the COVID-19 pandemic in 2019, during the second wave of the pandemic in spring 2020, and during the third wave of the pandemic in fall 2021.

    SETTING: The study was conducted at critical care units at a university hospital, Sweden.

    MAIN OUTCOME MEASURES: The MISSCARE Survey-Swedish version was used to collect data along with two study-specific questions concerning perception of patient safety and quality of care.

    RESULTS: Significantly more overtime hours and number of days absent due to illness were reported during the pandemic. The nurse/patient ratio was above the recommended level at all data collection time points. Most missed nursing care was reported in items concerning basic care. The most reported reasons for missed nursing care in all samples concerned inadequate staffing, urgent situations, and a rise in patient volume. Most nurses in all samples perceived the level of patient safety and quality of care as good, and the majority had no intention to leave their current position.

    CONCLUSION: The pandemic had a great impact on the critical care workforce but few elements of missed nursing care were affected. To measure and use missed nursing care as a quality indicator could be valuable for nursing managers, to inform them and improve their ability to meet changes in patient needs with different workforce approaches in critical care settings.

    Fulltekst (pdf)
    fulltext
  • 19. Farrohknia, Nasim
    et al.
    Castrén, Maaret
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Lind, Lars
    Oredsson, Sven
    Jonsson, Håkan
    Asplund, Kjell
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Emergency department triage scales and their components: a systematic review of the scientific evidence2011Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 19, nr 42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed:

    1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED?

    2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)?

    3. How valid is each triage scale in predicting hospitalization and hospital mortality?

    A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted.

    We found ED triage scales to be supported, at best, by limited and often insufficient evidence.

    The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

    Fulltekst (pdf)
    fulltext
  • 20. Farrokhnia, Nasim
    et al.
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Swedish emergency department triage and interventions for improved patient flows: a national update2011Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 19, nr 1, s. 72-72Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray. There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

    Fulltekst (pdf)
    fulltext
  • 21. Ferlander, Pia
    et al.
    Elfström, Cecilia
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    von Rosen, Anette
    Djärv, Therese
    Nonspecific abdominal pain in the Emergency Department: malignancy incidence in a nationwide Swedish cohort study2018Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 25, nr 2, s. 105-109Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTIONThe role of emergency physicians is to identify patients in need of immediate treatment, but also to identify symptoms indicative of serious, if not immediately life-threatening conditions. AIMTo assess whether symptoms described as nonspecific abdominal pain (NSAP) could be the first indication of an abdominal malignancy. MATERIALS AND METHODSThis was a nationwide registry-based cohort study of all patients discharged with NSAP from Swedish Emergency Departments (EDs) during the year 2011, based on Swedish patient registries of inpatient and outpatient care, and the cause of death registry, studying patients diagnosed with de novo cancer within a year after their NSAP discharge. RESULTSOf 24 801 patients discharged with NSAP in 2011, 2.2% were assigned a cancer diagnosis within 12 months. Almost 20% of patients diagnosed with a malignancy died within the year, and 16% of these deaths occurred within a month after the ED visit. The majority of patients with cancer were 60 years of age or older, and thus significantly older than the remaining NSAP patients. Patients with malignancies also had a greater number of comorbidities than the remaining NSAP patients (P<0.01). CONCLUSIONA small percentage of patients discharged with NSAP from Swedish EDs are diagnosed with a malignancy within a year. Patients aged 60 years or older and with comorbidities were over-represented in terms of developing malignancies after discharge. Emergency physicians should be aware of the fact that diffuse abdominal symptoms in elderly patients could be the first sign of an underlying malignancy and more liberally refer such patients for follow-up in primary care.

  • 22. Fossum, Mariann
    et al.
    Alexander, Greg L
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Registered nurses’ thinking strategies about malnutrition and pressure ulcer in nursing homes: a scenario-based think aloud study2011Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, nr 17-18, s. 2425-2435Artikkel i tidsskrift (Fagfellevurdert)
  • 23.
    Göransson, Katarina
    Örebro University, Örebro, Sweden.
    Registered nurse-led emergency department triage2007Inngår i: Australasian emergency nursing journal, ISSN 1574-6267, Vol. 10, nr 4, s. 202-202Artikkel i tidsskrift (Fagfellevurdert)
  • 24.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    De Waern, Michaela
    Lindmarker, Per
    Patients’ pathway to emergency care: is the emergency department their first choice of care?2013Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 20, nr 1, s. 45-50Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVESTo investigate whether patients came directly to the emergency department (ED) or whether they had taken any other actions or activities within the healthcare system before attending the ED. An additional aim was to increase our understanding of the potential determinants between patients’ ED-seeking behaviour and patient-related data. METHODSThis prospective descriptive study was carried out at the ED at a level one trauma centre at a university hospital in Sweden. During 12 weeks in 2008, a 20-item study-specific questionnaire was distributed by research assistants to patients arriving either by their own means or by ambulance to the ED. In addition, patient-specific data were gathered from the electronic patient records. RESULTSA total of 2014 patients participated in the study, of whom 1192 (59%) reported to have carried out healthcare-related actions or activities before their visit to the ED. A general practitioner was the most common (29.1%) healthcare provider to have been in contact with. Female patients and patients with a longer duration of symptoms sought other health caregivers before the ED visit to a significantly higher extent (P<0.001, 0.003). Other caregivers’ referral rate to the ED was 60.1–87.9%. Accessibility to other caregivers was generally rated as easy. CONCLUSIONA large proportion of ED patients sought previous healthcare before seeking care at the ED. Female patients and patients with longer symptom duration more often sought other caregivers before seeking ED care.

  • 25.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Fonteyn, Marsha E
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro University, Örebro, Sweden.
    Thinking strategies used by Registered Nurses during emergency department triage2008Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, nr 2, s. 163-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Title.  Thinking strategies used by Registered Nurses during emergency department triage Aim.  This paper is a report of a study to describe and compare thinking strategies and cognitive processing in the emergency department triage process by Registered Nurses with high and low triage accuracy. Background.  Sound clinical reasoning and accurate decision‐making are integral parts of modern nursing practice and are of vital importance during triage in emergency departments. Although studies have shown that individual and contextual factors influence the decisions of Registered Nurses in the triage process, others have failed to explain the relationship between triage accuracy and clinical experience. Furthermore, no study has shown the relationship between Registered Nurses’ thinking strategies and their triage accuracy. Method.  Using the ‘think aloud’ method, data were collected in 2004–2005 from 16 RNs working in Swedish emergency departments who had previously participated in a study examining triage accuracy. Content analysis of the data was performed. Findings.  The Registered Nurses used a variety of thinking strategies, ranging from searching for information, generating hypotheses to stating propositions. They structured the triage process in several ways, beginning by gathering data, generating hypotheses or allocating acuity ratings. Comparison of participants’ use of thinking strategies and the structure of the triage process based on their previous triage accuracy revealed only slight differences. Conclusion.  The wide range of thinking strategies used by Registered Nurses when performing triage indicates that triage decision‐making is complex. Further research is needed to ascertain which skills are most important in triage decision‐making.

  • 26.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    12. A Nurse's Role in Triage in a Swedish Emergency Department2004Inngår i: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 30, nr 5, s. 408-409Artikkel i tidsskrift (Fagfellevurdert)
  • 27.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, Örebro, Sweden.
    A national survey of emergency department triage in Sweden2003Inngår i: AMIA Annual Symposium Proceedings, E-ISSN 1942-597X, Vol. 2003, s. 851-851Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to identify the organisation of and knowledge about triage work in Swedish emergency departments (ED) as a first step to understanding what is necessary for decision support in ED triage systems in Sweden. A national survey using telephone interviews for data collection was used. Results showed great variety in how work regarding ED triage is organised and performed. The variety occurs in several areas including education, personnel performing triage, facilities available and scales used.

  • 28.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, Örebro, Sweden.
    Triage in emergency departments: national survey2005Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, nr 9, s. 1067-1074Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim.  This paper reports a study the aim of which was to describe how triage‐related work was organized and performed in Swedish emergency departments. Background.  Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue. Method.  A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden. Results.  The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings. Conclusion.  In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended. Relevance to clinical practice.  The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.

  • 29.
    Göransson, Katarina
    et al.
    Örebro University.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehnfors, Margareta
    Fonteyn, Marsha
    An effort to use qualitative data analysis software for analysing think aloud data2007Inngår i: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 76, nr Supplement 2, s. S270-S273Artikkel i tidsskrift (Fagfellevurdert)
  • 30.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, Örebro, Sweden.
    Fonteyn, Marsha
    Dana-Farber Cancer Center, Boston, MA, USA .
    The use of qualitative data analysis software (QDAS) to manage and support the analysis of think aloud (TA) data2006Inngår i: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 122, s. 143-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This methodological paper describes how qualitative data analysis software (QDAS) is being used to manage and support a three-step protocol analysis (PA) of think aloud (TA) data in a study examining emergency nurses' reasoning during triage. The authors believe that QDAS program QRS NVivo will greatly facilitate the PA and will allow them to identify and describe the information that triage nurses concentrate on during triage, and how they structure this information to make a triage decision. These findings could assist in designing and creating decision support systems to guide nurses' triaging. Additionally, details about how to use QRS NVivo for PA of TA data may assist and guide future informatics research using similar methodology are presented here. This innovative use of QDAS holds great promise for future nursing informatics research.

    Fulltekst (pdf)
    fulltext
  • 31.
    Göransson, Katarina
    et al.
    Örebro university.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Marklund, Bertil
    Ehnfors, Margareta
    Accuracy and concordance of nurses in emergency department triage2005Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, nr 4, s. 432-438Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the emergency department (ED) Registered Nurses (RNs) often perform triage, i.e. the sorting and prioritizing of patients. The allocation of acuity ratings is commonly based on a triage scale. To date, three reliable 5-level triage scales exist, of which the Canadian Triage and Acuity Scale (CTAS) is one. In Sweden, few studies on ED triage have been conducted and the organization of triage has been found to vary considerably with no common triage scale. The aim of this study was to investigate the accuracy and concordance of emergency nurses acuity ratings of patient scenarios in the ED setting. Totally, 423 RNs from 48 (62%) Swedish EDs each triaged 18 patient scenarios using the CTAS. Of the 7550 triage ratings, 57.6% were triaged in concordance with the expected outcome and no scenario was triaged into the same triage level by all RNs. Inter-rater agreement for all RNs was kappa = 0.46 (unweighted) and kappa = 0.71 (weighted). The fact that the kappa-values are only moderate to good and the low concordance between the RNs call for further studies, especially from a patient safety perspective.

  • 32.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro University, Örebro, Sweden.
    Marklund, Bertil
    Ehnfors, Margareta
    Emergency department triage: Is there a link between nurses’ personal characteristics and accuracy in triage decisions?2006Inngår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, nr 2, s. 83-88Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A common task of registered nurses is to perform emergency department triage, often using an especially designed triage scale in their assessment. However, little information is available about the factors that promote the quality of these decisions. This study investigated personal characteristics of registered nurses and the accuracy in their acuity ratings of patient scenarios. Using the Canadian Triage and Acuity Scale (CTAS), 423 registered nurses from 48 (62%) Swedish emergency departments individually triaged 18 patient scenarios. The registered nurses’ percentage of accurate acuity ratings was 58%, with a range from 22% to 89% accurate acuity ratings per registered nurse. In total, 60.3% of the registered nurses accurately triaged the scenarios in 50–69% of the cases. No relationship was found between personal characteristics of the registered nurses and their ability to triage. The lack of a relationship between personal characteristics of registered nurses and their ability to triage suggests that there might be intrapersonal characteristics, particularly the decision-making strategies used which can partly explain this dispersion. Future research that focuses on decision-making is likely to contribute in identifying and describing essential nursing characteristics for successful emergency department triage.

  • 33.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Eldh, Ann Catrine
    Jansson, Anna
    Triage på akutmottagning2008Bok (Annet vitenskapelig)
  • 34.
    Göransson, Katarina
    et al.
    Karolinska institutet, Stockholm.
    Förberg, Ulrika
    Karolinska University Hospital; Karolinska Institutet, Stockholm.
    Johansson, Eva
    Unbeck, Maria
    Danderyd Hospital, Karolinska Institutet, Stockholm.
    Measurement of peripheral venous catheter-related phlebitis: a cross-sectional study.2017Inngår i: The Lancet Haematology, E-ISSN 2352-3026, Vol. 4, nr 9, s. e424-e430, artikkel-id S2352-3026(17)30122-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Many instruments for measurement of peripheral venous catheter (PVC)-related phlebitis are available, but no consensus exists on their applicability in clinical practice. This absence of consensus affects the ability to identify and compare proportions of PVCs causing phlebitis within and across hospitals as the range varies between 2% and 62% in previous studies. We hypothesised that the instruments' ability to identify phlebitis varies. The aim of this study is to illustrate the complexity of application of phlebitis instruments to a clinical dataset.

    METHODS: In this cross-sectional study, we applied 17 instruments for phlebitis identification (divided into three groups [instruments using definitions, severity rating systems, and scoring systems]) to PVCs in adult patients admitted to 12 inpatient units at Karolinska University Hospital in Sweden. We calculated the proportion of PVCs causing phlebitis on the basis of each instrument's minimum criterion for phlebitis. We also analysed each instrument's face validity. We compared proportions using the Z test.

    FINDINGS: On the basis of data collected between Feb 2, 2009, and Feb 20, 2009, May 18, 2009, and June 5, 2009, and Feb 8, 2010, and Feb 26, 2010, we applied 17 instruments for phlebitis identification (eight instruments using definitions, seven severity rating systems, and two scoring systems) to 1175 observed PVCs in 1032 patients. The highest number of PVCs causing phlebitis generated by definitions was 137 (11·7%), by severity rating systems was 395 (33·6%), and by scoring systems was 363 (30·9%). The proportion generated by instruments using definitions was significantly different to that of both the severity rating (difference 21·9% [95% CI 18·6-25·2]; p<0·0001) and scoring (19·2% [12·0-26·4]; p<0·0001) systems. Proportions did not differ significantly between severity rating systems and scoring system (difference 2·7% [95% CI -1·1 to 6·6]; p=0·16). The proportion within instruments ranged from less than 1% to 28%. We identified face validity issues, such as use of indistinct or complex measurements and inconsistent measurements or definitions.

    INTERPRETATION: Our study highlights several concerns regarding instruments to measure phlebitis published in the scientific community. From a work environment and patient safety perspective, clinical staff engaged in PVC management should be aware of the absence of adequately validated instruments for phlebitis assessment. We suggest that researchers within the field of PVC come together in a joint research programme aiming to develop valid and reliable methods that accurately identify PVC-related adverse events that also includes decision support for clinical staff concerning clinical indications for PVC removal. Such actions could lead to a revised view on what is best practice for management of PVCs.

    FUNDING: None.

  • 35.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Heilborn, Umut
    Djärv, Therese
    Patients' perspectives on the insufficiency of scales to rate their pain in the ED2016Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 34, nr 11, s. 2246-2247Artikkel i tidsskrift (Fagfellevurdert)
  • 36.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Heilborn, Umut
    Selberg, Josefin
    von Scheele, Susanna
    Djärv, Therese
    Pain rating in the ED—a comparison between 2 scales in a Swedish hospital2015Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 33, nr 3, s. 419-422Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract Background Pain is common at an emergency department (ED). Two common scales used to rate intensity are the visual analog scale (VAS) and the numeric rating scale (NRS), but it remains unknown which is superior to use in the ED. Aim The aim of the study is to compare correlations between values on the VAS and the NRS in patients visiting the ED as well as to assess the patients' preference of scale. Methods Patients who visited the ED due to chest pain, abdominal pain, or an orthopedic condition during autumn 2012 were enrolled onto a cross-sectional study with a consecutive sample. Patients rated their pain using the VAS and NRS scales. They answered an open-ended oral questionnaire regarding their preference and their estimation of the sufficiency of the scales. Data were analyzed with significance test. Results In all, 217 patients (70% of eligible, 94% of invited) participated. The pain scores generated from the NRS and the VAS were found to strongly correlate (mean difference, 0.41; 95% confidence interval, 0.29-0.53). Most patients found the NRS easier to use than the VAS (61% and 22%, respectively; P < .001). Furthermore, a majority reported that the NRS reflected/described their pain better than the VAS (53% and 26%, respectively; P < .01). Conclusion Because values on the NRS correspond well to values on the VAS, values rated with different scales over time might be comparable. Because a majority of the patients found the NRS scale simpler to use and preferred it over the VAS, it might be more appropriate to use in the ED.

  • 37.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Johansson, Eva
    Indication and Usage of Peripheral Venous Catheters Inserted in Adult Patients during Emergency Care2011Inngår i: Journal of Vascular Access, ISSN 1129-7298, E-ISSN 1724-6032, Vol. 12, nr 3, s. 193-199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose The aim of this study was to identify the underlying decisions taken regarding the insertion of prehospital peripheral venous catheters in adult patients and, additionally, to ascertain peripheral venous catheter insertion rate and explore prehospital and hospital (within 24 hours of insertion) pharmaceutical treatment via peripheral venous catheters. Method This cross-sectional study gathered data through a study-specific questionnaire and patient record auditing. We distributed a study-specific questionnaire to be completed by ambulance crews, and carried out patient record auditing for 345 patients (median age 64 years, range 18–97 years) arriving at the emergency department at a Swedish level-1 trauma center in October 2008. Results Of 135 patients (39%) arriving at the emergency department with a peripheral venous catheter, 94 (70%) had received the device because the ambulance crews intended to use it for intravenous therapeutics (of which analgesics, intravenous fluids, and psycholeptics were most frequently used). In 30 patients (22%), the prehospital inserted device was not used by the ambulance crews or at hospital within 24 hours. The corresponding rate of unused peripheral venous catheters inserted in patients after arrival at the hospital was 35%. Conclusions We found that the main reason for the ambulance staff to insert a peripheral venous catheter in a prehospital setting was that they intended to use the device. Further, the rate of unused peripheral venous catheters was lower among prehospital peripheral venous catheters than hospital.

  • 38.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Johansson, Eva
    Prehospital Peripheral Venous Catheters: A Prospective Study of Patient Complications2012Inngår i: Journal of Vascular Access, ISSN 1129-7298, E-ISSN 1724-6032, Vol. 13, nr 1, s. 16-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose To investigate prehospital peripheral venous catheters (PVCs) in relation to the frequency of thrombophlebitis. Method Data in this prospective study were collected using three types of data source: a study-specific questionnaire, a PVC observation instrument (PVC assess), and electronic patient records. The questionnaire was distributed to ambulance crews who had inserted a PVC before bringing the patient to an emergency department at a level one trauma centre in Sweden during 10 weeks in 2008–2009. Patients admitted to hospital ward were followed-up daily by registered nurses using the PVC assess until the PVC was removed. Patient record data were collected by means of auditing. Results Of the 83 patients available for follow-up, 45 (54%) developed thrombophlebitis. Quick PVC removal was performed in 32 (71%) of these patients while 13 (29%) PVCs were left in situ for 1–8 days. No association was found between the occurrence of thrombophlebitis and potential risk factors. Conclusions Although thrombophlebitis frequently occurred in PVCs inserted in a prehospital setting, early removal of the device with complication was common. Further studies are warranted to identify the optimal in situ time for PVCs inserted by prehospital emergency teams.

  • 39.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Johansson, Eva
    Prehospital peripheral venous catheters: Incidence and usage2009Inngår i: Australasian emergency nursing journal, ISSN 1574-6267, Vol. 12, nr 4, s. 169-169Artikkel i tidsskrift (Fagfellevurdert)
  • 40.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Rosen, Anette
    Interrater agreement: a comparison between two emergency department triage scales2011Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 18, nr 2, s. 68-72Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVEThe aim was to elucidate if, by strictly applying the Adaptive Process Triage (ADAPT) scale, the interrater agreement increased among the participating registered nurses (RNs) than when triaging according to the older scale, which allowed subjective interpretations of signs and symptoms. METHODSNineteen patient scenarios were triaged in 2006 by 45 RNs using the previous triage scale, and in 2008 by 30 RNs using ADAPT. RESULTSThere was no significant difference (P=0.65) between the two triage scales with regard to level of overall exact agreement (κ value 0.529 vs. 0.472). The same triage level was more often chosen when using the ADAPT system as compared to the earlier triage scale and dispersion across the triage levels was also reduced when using ADAPT. Eight (42%) of the patient scenarios were triaged as both unstable and stable by ADAPT, and 11 (58%) when the older scale was applied. Fourteen (74%) of the scenarios could not be allocated to a defined triage level by ADAPT. Five main reasons for such triage decisions were identified. CONCLUSIONBoth the triage scales showed moderate overall agreements, while dispersion of triage decisions across several triage levels declined when ADAPT was used. Although the algorithm for acuity allocation by ADAPT seemed well defined, many patient scenarios were triaged as both unstable and stable and thus allocated to various triage levels. If ADAPT is to function as a safe triage tool with low interrater variability, further revision of the triage algorithms is needed.

  • 41.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Rosen, Anette
    Patient experience of the triage encounter in a Swedish emergency department2010Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 18, nr 1, s. 36-40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Emergency department triage is a prerequisite for the rapid identification of critically ill patients and for allocation of the correct acuity level which is pivotal for medical safety. The patient’s first encounter with a medical professional in the emergency department is often with the triage nurse. To identify patient experience of the triage encounter. A questionnaire focusing on the patient–triage nurse relationship in terms of satisfaction with the medical and administrative information, privacy and confidentiality in the triage area as well as triage nurse competence and attitude was answered by 146 participating patients. The majority of patients perceived that while they were triaged immediately upon arrival to the emergency department, they were often given limited information about the waiting time. Although almost a quarter of the patients did not wish to have information about their medical condition from the triage nurse, 97% of the patients considered the triage nurse to be medically competent for the triage task. Patients were generally satisfied with the reception and care given by the triage nurses, but less satisfied about information about expected waiting time. We suggest therefore, that patients should be routinely informed about their estimated waiting time to be seen by the doctor in addition to their triage level.

  • 42.
    Göransson, Katarina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Rosen, Anette
    The triage encounter from the patient perspective2009Inngår i: Australasian emergency nursing journal, ISSN 1574-6267, Vol. 12, nr 4, s. 158-158Artikkel i tidsskrift (Fagfellevurdert)
  • 43. Hommel, Ami
    et al.
    Magnéli, Martin
    Samuelsson, Bodil
    Schildmeijer, Kristina
    Sjöstrand, Desirée
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Unbeck, Maria
    Karolinska Institutet.
    Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: A multicenter cohort study using Global Trigger Tool.2020Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 102, artikkel-id 103473Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: For decades, patient safety has been recognized as a critical global healthcare issue. However, there is a gap of knowledge of all types of adverse events sensitive to nursing care within hospitals in general and within orthopaedic care specifically.

    OBJECTIVES: The aim of this study is to explore the incidence and nature of nursing-sensitive adverse events following elective or acute hip arthroplasty at a national level.

    DESIGN: A retrospective multicenter cohort study.

    OUTCOME VARIABLES: Nursing-sensitive adverse events, preventability, severity and length of stay.

    METHODS: All patients, 18 years or older, who had undergone an elective (degenerative joint disease) or acute (fractures) hemi or total hip arthroplasty surgery at 24 hospitals were eligible for inclusion. Retrospective reviews of weighted samples of 1998 randomly selected patient records were carried out using the Swedish version of the Global Trigger Tool. The patients were followed for readmissions up to 90 days postoperatively throughout the whole country regardless of index hospital.

    RESULTS: A total of 1150 nursing-sensitive adverse events were identified in 728 (36.4%) of patient records, and 943 (82.0%) of the adverse events were judged preventable in the study cohort. The adjusted cumulative incidence regarding nursing-sensitive adverse events for the study population was 18.8%. The most common nursing-sensitive adverse event types were different kinds of healthcare-associated infections (40.9%) and pressure ulcers (16.5%). Significantly higher proportions of nursing-sensitive adverse events were found among female patients compared to male, p < 0.001, and patients with acute admissions compared to elective patients, p < 0.001. Almost half (48.5%) of the adverse events were temporary and of a less severe nature. On the other hand, 592 adverse events were estimated to have contributed to 3351 extra hospital days.

    CONCLUSIONS: This study shows the magnitude of nursing-sensitive adverse events. We found that nursing-sensitive adverse events were common, in most cases deemed preventable and were associated with different kinds of adverse events and levels of severity in orthopaedic care. Registered nurses play a vital role within the interdisciplinary team as they are the largest group of healthcare professionals, work 24/7 and spend much time at the bedside with patients. Therefore, nursing leadership at all hospital levels must assume responsibility for patient safety and authorize bedside registered nurses to deliver high-quality and sustainable care to patients.

  • 44. Kanstrup, Marie
    et al.
    Rudman, Ann
    Göransson, Katarina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Andersson, Emil
    Lauri, Klara Olofsdotter
    Rapoport, Emma
    Sunnergård, Linda
    Bragesjö, Maria
    Andersson, Erik
    Iyadurai, Lalitha
    Holmes, Emily A
    Reaching people soon after a traumatic event: an exploratory observational feasibility study of recruitment in the emergency department to deliver a brief behavioral intervention via smartphone to prevent intrusive memories of trauma.2021Inngår i: Pilot and feasibility studies, ISSN 2055-5784, Vol. 7, nr 1, artikkel-id 184Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The current study explored how to recruit patients soon after a traumatic event, to deliver a novel intervention in a new emergency department in Sweden. This brief behavioral intervention aims to prevent intrusive memories and is delivered soon after trauma in the emergency department. In the UK, it has shown promising results. Traumatic events resulting in admission to the emergency department (e.g., road traffic accidents) may result in subsequent mental health problems such as post-traumatic stress disorder, where intrusive memories of the trauma constitute a core clinical feature. Early interventions that prevent intrusive memories after psychological trauma are lacking. Specific aims were to explore identification of eligible patients (aim 1), fitting in with emergency department staff routines to deliver the study protocol (aim 2), and using the patients' own smartphones to deliver intervention/control task (aim 3). Two changes to the previous study were (i) extending the trauma types included (ii) a new control condition, also by smartphone.

    METHODS: This is an explorative observational study. Data was both analyzed descriptively and using the Framework method.

    RESULTS: We identified several possible ways to recruit patients, and establish a sense of embeddedness in the Swedish emergency department context and a positive appreciation from staff. The study protocol was tested with 8 participants. Tasks both in the intervention and control condition were readily delivered via patients' own smartphones.

    CONCLUSION: Recruitment of patients and smartphone delivery of the intervention indicates initial feasibility. Researcher presence and administration of study procedures was successfully fitted to emergency department routines and well received by staff. Further pilot work is warranted, underscoring the importance of our collaboration between nursing and psychology.

    Fulltekst (pdf)
    fulltext
  • 45. Kanstrup, Marie
    et al.
    Singh, Laura
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Gamble, Beau
    Taylor, Rod S
    Iyadurai, Lalitha
    Moulds, Michelle L
    Holmes, Emily A
    A simple cognitive task intervention to prevent intrusive memories after trauma in patients in the Emergency Department: A randomized controlled trial terminated due to COVID-192021Inngår i: BMC Research Notes, E-ISSN 1756-0500, Vol. 14, nr 1, s. 176-176Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract Objective This randomised controlled trial (RCT) aimed to investigate the effects of a simple cognitive task intervention on intrusive memories ("flashbacks") and associated symptoms following a traumatic event. Patients presenting to a Swedish emergency department (ED) soon after a traumatic event were randomly allocated (1:1) to the simple cognitive task intervention (memory cue + mental rotation instructions + computer game "Tetris" for at least 20 min) or control (podcast, similar time). We planned follow-ups at one-week, 1-month, and where possible, 3- and 6-months post-trauma. Anticipated enrolment was N = 148. Results The RCT was terminated prematurely after recruiting N = 16 participants. The COVID-19 pandemic prevented recruitment/testing in the ED because: (i) the study required face-to-face contact between participants, psychology researchers, ED staff, and patients, incurring risk of virus transmission; (ii) the host ED site received COVID-19 patients; and (iii) reduced flow of patients otherwise presenting to the ED in non-pandemic conditions (e.g. after trauma). We report on delivery of study procedures, recruitment, treatment adherence, outcome completion (primary outcome: number of intrusive memories during week 5), attrition, and limitations. The information presented and limitations may enable our group and others to learn from this terminated study. Trial registration ClinicalTrials.gov: NCT04185155 (04-12-2019)

    Fulltekst (pdf)
    fulltext
  • 46. Kanstrup, Marie
    et al.
    Singh, Laura
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Widoff, Julia
    Taylor, Rod S
    Gamble, Beau
    Iyadurai, Lalitha
    Moulds, Michelle L
    Holmes, Emily A
    Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department: an exploratory pilot randomised controlled trial2021Inngår i: Translational Psychiatry, E-ISSN 2158-3188, Vol. 11, nr 1, s. 30-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, resulted in intrusion reduction over the subsequent week. Its feasibility in a different setting and longer-term effects (>1 month) need investigation. We conducted an exploratory open-label pilot randomised controlled trial (RCT) to investigate the feasibility and effects of a brief behavioural intervention to reduce intrusive memories in trauma-exposed patients in a Swedish hospital emergency department (ED). Participants (final N = 41) were randomly allocated to either intervention (including memory reminder cue then visuospatial cognitive task "Tetris" with mental rotation instructions) or active control (podcast) condition within 72 h of presenting to the ED (both conditions using their smartphone). Findings were examined descriptively. We estimated between-group effect sizes for the number of intrusive memories post-intervention at week 1 (primary outcome) and week 5 (secondary outcome). Compared to the control condition, participants in the intervention condition reported fewer intrusive memories of trauma, both at week 1 and week 5. Findings extend the previous evaluation in the UK. The intervention was readily implemented in a different international context, with a mixed trauma sample, with treatment gains maintained at 1 month and associated with some functional improvements. Findings inform future trials to evaluate the capacity of the cognitive task intervention to reduce the occurrence of intrusive memories after traumatic events.

    Fulltekst (pdf)
    fulltext
  • 47. Källberg, Ann-Sofie
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Medical errors in Swedish emergency departments: A national review2010Inngår i: European Society of Emergency Medicine, Stockholm, Sverige, 2010Konferansepaper (Annet vitenskapelig)
  • 48.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Patient safety risks in the emergency department2016Konferansepaper (Fagfellevurdert)
  • 49.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Physicians' and nurses' perceptions of patient safety risks in the emergency department2017Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, s. 14-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks.

    METHOD: Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.

    RESULTS: The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.

    CONCLUSION: The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.

  • 50. Källberg, Ann-Sofie
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Medical errors regarding emergency department care reported to national authorities in Sweden by care providers and patients2011Inngår i: Australasian emergency nursing journal, ISSN 1574-6267, Vol. 14, s. S18-S18Artikkel i tidsskrift (Fagfellevurdert)
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